MEDICARE: ASHLEY GREEN BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-20-41243	CA

General Provider Information

NPI Number	:	1366065252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY GREEN BCBA

Provider Business Mailing Address
First Line	:	2007 W HEDDING ST STE 201
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-1428
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1505 PAINTED FEATHER CT
Second Line	:
City	:	MORGAN HILL
State	:	CA
Zip	:	95037-9009
Country	:	US
Telephone Number	:	408-431-7630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2020
Last Update Date	:	05/26/2020

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Directions to “ ASHLEY GREEN BCBA” Practice Location

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